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Individual
KELLY RENEE BLACK
Active
Individual
KELLY RENEE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
PA
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116670800
—
FL
Enumeration date
09/08/2017
Last updated
05/18/2026
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